{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T12:34:50Z","timestamp":1793709290398,"version":"4.6.1"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Urogynecol J"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Refractory overactive bladder (OAB) lacks formal definition and is poorly understood. Its management requires patients to choose an invasive treatment, including intravesical botulinum toxin A (BOTOX\u00ae), sacral neuromodulation (SNM) and posterior tibial nerve stimulation (PTNS), which have varying rates of efficacy and side effects. These decisions can be complex for patients to make, especially within the time constraints of outpatient clinic appointments. A new patient decision aid (PDA) has been developed to support patients during this shared decision-making process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study assesses decisional conflict scores and patient satisfaction in those who use a novel PDA for refractory OAB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive new patients with refractory OAB were provided with the PDA prior to decision-making. Patients then had a virtual follow-up appointment to assess their decisional conflict, using a validated scale. The total decisional conflict score was calculated. Treatment choice and free-text feedback were also analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-five patients were included. Following use of the PDA, a range of treatment choices were made, including SNM (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096), PTNS (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910), BOTOX\u00ae (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096) and continuation with medical therapy (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093). Overall, decisional conflict was low, with 100% of patients having a score of less than 25. Subscores suggested improved patient understanding, with the PDA increasing clarification.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Introduction of this novel PDA, in those requiring treatment for refractory OAB, was associated with low decisional conflict and positive patient feedback. This supports its use in shared decision-making, empowering patients to make an informed and individualised choice regarding their treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00192-026-06688-3","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T14:23:18Z","timestamp":1779200598000},"page":"3263-3267","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Decision-Making in Refractory Overactive Bladder: Evaluation of a Novel Patient Decision Aid and its Impact on Decisional Conflict"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6739-5014","authenticated-orcid":false,"given":"Rayan","family":"Mohamed-Ahmed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angie","family":"Rantell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annika","family":"Taithongchai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Araklitis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dudley","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"issue":"1","key":"6688_CR1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s00192-009-0976-9","volume":"21","author":"BT Haylen","year":"2010","unstructured":"Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)\/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5\u201326.","journal-title":"Int Urogynecol J"},{"key":"6688_CR2","doi-asserted-by":"crossref","unstructured":"Urinary incontinence and pelvic organ prolapse in women: management. 2019;NICE NG123.","DOI":"10.1111\/bju.14763"},{"issue":"11","key":"6688_CR3","doi-asserted-by":"publisher","first-page":"e021889","DOI":"10.1136\/bmjopen-2018-021889","volume":"8","author":"G Yeowell","year":"2018","unstructured":"Yeowell G, Smith P, Nazir J, Hakimi Z, Siddiqui E, Fatoye F. Real-world persistence and adherence to oral antimuscarinics and mirabegron in patients with overactive bladder (OAB): a systematic literature review. BMJ Open. 2018;8(11):e021889.","journal-title":"BMJ Open"},{"key":"6688_CR4","doi-asserted-by":"publisher","DOI":"10.1016\/j.cont.2023.101066","volume":"9","author":"R Mohamed-Ahmed","year":"2024","unstructured":"Mohamed-Ahmed R, Tomlinson C, Taithongchai A, Rantell A, Araklitis G, Robinson D, et al. Long term safety outcomes and continuation rates of repeated intravesical botulinum toxin A injections for detrusor overactivity: 16 year\u2019s experience of a tertiary centre in the UK. Continence Oxf. 2024;9:101066.","journal-title":"Continence Oxf"},{"issue":"1","key":"6688_CR5","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1111\/j.1464-410X.2012.11282.x","volume":"111","author":"A Mohee","year":"2013","unstructured":"Mohee A, Khan A, Harris N, Eardley I. Long-term outcome of the use of intravesical botulinum toxin for the treatment of overactive bladder (OAB). BJU Int. 2013;111(1):106\u201313.","journal-title":"BJU Int"},{"issue":"5","key":"6688_CR6","doi-asserted-by":"publisher","first-page":"1482","DOI":"10.1002\/nau.24376","volume":"39","author":"K Benson","year":"2020","unstructured":"Benson K, McCrery R, Taylor C, Padron O, Blok B, de Wachter S, et al. One-year outcomes of the ARTISAN-SNM study with the Axonics system for the treatment of urinary urgency incontinence. Neurourol Urodyn. 2020;39(5):1482\u20138.","journal-title":"Neurourol Urodyn"},{"issue":"2","key":"6688_CR7","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1002\/nau.24615","volume":"40","author":"A Pezzella","year":"2021","unstructured":"Pezzella A, McCrery R, Lane F, Benson K, Taylor C, Padron O, et al. Two-year outcomes of the ARTISAN-SNM study for the treatment of urinary urgency incontinence using the Axonics rechargeable sacral neuromodulation system. Neurourol Urodyn. 2021;40(2):714\u201321.","journal-title":"Neurourol Urodyn"},{"issue":"2","key":"6688_CR8","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1002\/nau.24254","volume":"39","author":"MJ Te Dorsthorst","year":"2020","unstructured":"Te Dorsthorst MJ, Heesakkers J, van Balken MR. Long-term real-life adherence of percutaneous tibial nerve stimulation in over 400 patients. Neurourol Urodyn. 2020;39(2):702\u20136.","journal-title":"Neurourol Urodyn"},{"issue":"1","key":"6688_CR9","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/j.juro.2017.01.078","volume":"198","author":"HMK van Breda","year":"2017","unstructured":"van Breda HMK, Martens FMJ, Tromp J, Heesakkers J. A new implanted posterior tibial nerve stimulator for the treatment of overactive bladder syndrome: 3-month results of a novel therapy at a single center. J Urol. 2017;198(1):205\u201310.","journal-title":"J Urol"},{"issue":"11","key":"6688_CR10","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1080\/17434440.2023.2254678","volume":"20","author":"MJ Bressington","year":"2023","unstructured":"Bressington MJ, Scholtz D, Hooshiary A, Vermeulen W, Burns T, Ordones F, et al. Device evaluation: eCoin \u2013 implantable tibial nerve stimulator for overactive bladder. Expert Rev Med Devices. 2023;20(11):899\u2013904.","journal-title":"Expert Rev Med Devices"},{"issue":"4","key":"6688_CR11","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1136\/bmjebm-2022-112068","volume":"28","author":"VM Montori","year":"2023","unstructured":"Montori VM, Ruissen MM, Hargraves IG, Brito JP, Kunneman M. Shared decision-making as a method of care. BMJ Evid Based Med. 2023;28(4):213\u20137.","journal-title":"BMJ Evid Based Med"},{"issue":"2","key":"6688_CR12","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1177\/10775587211012995","volume":"79","author":"C LeRouge","year":"2022","unstructured":"LeRouge C, Nguyen AM, Bowen DJ. Patient decision aid selection for shared decision making: a multicase qualitative study. Med Care Res Rev. 2022;79(2):267\u201380.","journal-title":"Med Care Res Rev"},{"issue":"4","key":"6688_CR13","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1080\/14760584.2020.1742111","volume":"19","author":"S Bruel","year":"2020","unstructured":"Bruel S, Leclercq T, Ginzarly M, Botelho-Nevers E, Frapp\u00e9 P, Gagneux-Brunon A. Patient decision aid in vaccination: a systematic review of the literature. Expert Rev Vaccines. 2020;19(4):305\u201311.","journal-title":"Expert Rev Vaccines"},{"key":"6688_CR14","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.2147\/COPD.S392191","volume":"18","author":"Y Jiang","year":"2023","unstructured":"Jiang Y, Guo J, Chen M, Zou X, Sun P, Gao J, et al. Development of a pulmonary rehabilitation patient decision aid for patients with chronic obstructive pulmonary disease: mixed methods study. Int J Chron Obstruct Pulmon Dis. 2023;18:1377\u201389.","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"issue":"6","key":"6688_CR15","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1097\/GCO.0000000000000120","volume":"26","author":"B Tucker Edmonds","year":"2014","unstructured":"Tucker Edmonds B. Shared decision-making and decision support: their role in obstetrics and gynecology. Curr Opin Obstet Gynecol. 2014;26(6):523\u201330.","journal-title":"Curr Opin Obstet Gynecol"},{"issue":"1","key":"6688_CR16","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1177\/0272989X08327067","volume":"29","author":"A LeBlanc","year":"2009","unstructured":"LeBlanc A, Kenny DA, O\u2019Connor AM, L\u00e9gar\u00e9 F. Decisional conflict in patients and their physicians: a dyadic approach to shared decision making. Med Decis Making. 2009;29(1):61\u20138.","journal-title":"Med Decis Making"},{"issue":"9","key":"6688_CR17","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1007\/s00192-019-03982-1","volume":"30","author":"S Jha","year":"2019","unstructured":"Jha S, Duckett J. Utility of patient decision aids (PDA) in stress urinary incontinence surgery. Int Urogynecol J. 2019;30(9):1483\u20136.","journal-title":"Int Urogynecol J"},{"issue":"12","key":"6688_CR18","doi-asserted-by":"publisher","first-page":"1817","DOI":"10.1111\/1471-0528.18311","volume":"132","author":"R Bugeja","year":"2025","unstructured":"Bugeja R, Athey R, Jha S. Patient decision aids for pelvic floor surgery and impact on decisional conflict. BJOG. 2025;132(12):1817\u201322.","journal-title":"BJOG"},{"issue":"2","key":"6688_CR19","doi-asserted-by":"publisher","first-page":"e309","DOI":"10.1097\/SPV.0000000000000916","volume":"27","author":"SA Collins","year":"2021","unstructured":"Collins SA, Mueller MG, Geynisman-Tan J, Lewicky-Gaupp C, Kenton K. Impact of a Web-based decisional aid on satisfaction in women undergoing prolapse surgery. Female Pelvic Med Reconstr Surg. 2021;27(2):e309\u201314.","journal-title":"Female Pelvic Med Reconstr Surg"},{"key":"6688_CR20","unstructured":"OAB answers. Helping you make decisions about treatment for overactive bladder. 2025. https:\/\/www.supportincontinence.org\/wp-content\/uploads\/2025\/03\/Interactive-Overactive-Bladder-PDA_v0.2_11MAR2025.pdf"},{"issue":"1","key":"6688_CR21","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1177\/0272989X9501500105","volume":"15","author":"AM O\u2019Connor","year":"1995","unstructured":"O\u2019Connor AM. Validation of a decisional conflict scale. Med Decis Making. 1995;15(1):25\u201330.","journal-title":"Med Decis Making"},{"issue":"4","key":"6688_CR22","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1258\/0969141042467386","volume":"11","author":"M Gattellari","year":"2004","unstructured":"Gattellari M, Ward JE. Will men attribute fault to their GP for adverse effects arising from controversial screening tests? An Australian study using scenarios about PSA screening. J Med Screen. 2004;11(4):165\u20139.","journal-title":"J Med Screen"},{"key":"6688_CR23","doi-asserted-by":"publisher","DOI":"10.1016\/j.cont.2024.101341","volume":"11","author":"R Mohamed-Ahmed","year":"2024","unstructured":"Mohamed-Ahmed R, Lor KY, Taithongchai A, Rantell A, Araklitis G, Robinson D. Long term safety, continuation rates and subjective and objective success of posterior tibial nerve stimulation for overactive bladder. Continence. 2024;11:101341.","journal-title":"Continence"}],"container-title":["International Urogynecology Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-026-06688-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00192-026-06688-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00192-026-06688-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T11:58:16Z","timestamp":1793707096000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00192-026-06688-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":23,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["6688"],"URL":"https:\/\/doi.org\/10.1007\/s00192-026-06688-3","relation":{},"ISSN":["0937-3462","1433-3023"],"issn-type":[{"value":"0937-3462","type":"print"},{"value":"1433-3023","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]},"assertion":[{"value":"3 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study evaluated the quantitative impact of a novel PDA on decisional conflict amongst women with refractory OAB. Ethical approval was not required for this study, in keeping with the NHS Health Research Authority Research Ethics Committee. The study was registered as a quality improvement project within the department, to assess regular implementation of the PDA within the unit.","order":1,"name":"Ethics","label":"Ethics Approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Dudley Robinson reports a relationship with AbbVie Inc that includes speaking and lecture fees. The other authors have no relevant disclosures.","order":2,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}